An assessment of community health workers in Nicaragua

In 1981, the Ministry of Health of Nicaragua began a series of health campaigns whose front-line workers were volunteers from the community called 'brigadistas.' These volunteers have since evolved into a type of community health worker with a multi-disciplinary role and are now called 'primary health care brigadistas'. These brigadistas were formed with the intention of encouraging local community involvement in health and as a means of overcoming rural health manpower shortages. However, in field research at two sites, these primary health care brigadistas were found to have rather limited roles and were dependent upon the nurse auxiliary for direction. A current debate in the Ministry of Health centers around the future role of the brigadistas and their degree of accountability to the Ministry of Health and the Popular Organizations. This article suggests that the brigadistas may be underutilized at present and that increasing their training and expanding their role may be necessary to adequately meet rural health care needs.